“No Blood, just Sweat and Tears” is the title of a talk I give on menopause to women’s groups. Most women who hear this chuckle, so if you do not understand the play on words, then you are too young to be reading this blog post! Seriously, though, as a fellow woman who is also in this era of her life, I’ve got a few thoughts on this topic.
The average age for menopause is around 52 for the majority of women. Menopause, commonly referred to as “The Change,” is medically defined as no menstrual period for one year. How a woman crosses over into menopause is very unpredictable. For some it may be a few months of irregular periods, a few flushes, some sleeplessness, or feeling a little blue. For others it becomes a real trial in dealing with an upheaval of emotions, nightly multiple interruptions of sleep with night sweats, painful intercourse and a daily, unpredictable unleashing of hot flashes.
We have a variety of measures from simple lifestyle modifications to safe, reliable medical therapy that can ease a woman through menopause and restore her sense of well-being. Though you may feel like you are “driven to drink” at this time of your life, avoiding or limiting your alcohol intake in the evening can actually lessen the night time awakening and night sweats. Some women find spicy foods or caffeine to be a daytime and even nighttime trigger.
For vaginal dryness, we now have over-the-counter lubricants that last several days. Symptoms can also be relieved with vaginal estrogen tablets which release micro doses of medication to restore the vagina and are considered safe, even for those women who have had breast cancer. There is also a vaginal estrogen ring that slowly releases medication over 3 months. A newer, innovative medication in oral form is now available for women who do not want any estrogen product and specifically targets vaginal dryness.
For the relief of hot flashes and night sweats many have benefit from taking a lesser dose of an SSRI (Venlafaxine, as an example) and some of the older hypertensive meds even help. Women report relief from a variety of herbal products such as Soy, Black Cohash, St. John’s Wort, or Evening Primrose Oil, but randomized trials have not substantiated their use over placebo. If you choose to try herbals, be aware that herbal products can interfere with other medications and always tell your health care provider what you are taking.
Most women can benefit from hormone replacement therapy (HRT). This can be given by pills or by patches worn on the skin and a variety of dosing schedules to flexibly relieve a woman’s symptoms. Many women worry about a risk for causing breast cancer with hormone replacement therapy, but good data we now have tells us HRT is safe to use for the majority of women. ACOG recommends HRT to be the smallest dose combination for the shortest duration of time to relieve symptoms. This can be for several months to several years, but most women only need therapy for a few years. The duration and dosing is always something you and your doctor decide along with the risks and benefits for your individual case.